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<br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Depanmern of Natural Resources ~® <br />1713 Sherman St., Room 21 i EGE~V <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 CONSTRUCTION MATERIALS Z~Q, <br />FA%: (303) 832-8106 REGULAR (112) OPERATION pEC p 1 <br />RECLAMATION PERMIT APPLICATION FORM tstoaotMtoatatSaodGa+ <br />CHECK ONE: Yes There u a File Number Already Aaaigned to thia Operation <br />Permit # M - $ 3 - ~D 6 7 (Please reference the file number cutrentty assigned to this operation) <br />~~ <br />DIVISION OF <br />MINERALS <br />(GEOLOGY <br />RECLAMATION <br />~MINING•SAFETY <br />Bill Owens <br />Governor <br />Greg E. Walther <br />Executive Director <br />Michael B. LOng <br />New Application (Rule 1.4.5) X Amendment Application (Rule 1.10) Division Director <br />Conversion Application (Rule 1.11) <br />Permit # M - 83 -,~-~67 (provide for Amendments and Converaioty of existing permits) <br />The apphcation for a Copstruction Materials Regplar 112 Operstion Reclamation Permit contains three major parts: (I) the apphcation form; <br />(2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geoteolmical Stability Exhibit; and (3) the application fa. When you submit your <br />application, be sure to include one (1) complete si®ed and notarized IVORY ORIGINAL and four (4) copies of the completed I~ <br />application form, five (5) copies of Exhibits A-S, Addrndtim 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check far <br />the application fee described under Section (4) below. Exhibits should NOT be bound ar in a 3-ring binder, maps should be folded to <br />8 12" X 11" or 8 12" X 14" size. To expedite processing, please provide the information in the format and order described m this form. <br /> GENERAL OPERATION INFORMATION <br />Type or print clearly, in the apace provided, all information deacribed below. <br />1. App licaat/operator or rompanv name (name to be used op permit): <br /> Mobile Premix Concrete, Inc., a subsidiary of Lafarge ;forth America Inc. <br /> 1.1 Type of organization (corporation, partnership, etc.): Corporation <br /> 1.2 I.R.S. Tax I.D. No. or Social Security Number: <br />2. Ope ration name (pk. mine or site name): Stagecoach Mine <br />3. Permitted acreaee (new or e=istin>• site): 5 2 permitted acres <br /> 3.1 Chapge in acreage (+) -2.5 acres <br /> 3.2 Total acruge in Permit area 49.5 acres <br />4. Fees: <br /> 4. I New Application 52.344.1x1 apphcatioa fce <br /> 4.2 New Quarry Application 52.906.00 quarry application <br /> 4.4 Amendment Fee S 1.938.00 amendmwt fce <br /> 4.5 Conversion to i l2 operation (set by statute) 52.344.00 conversion fee <br />5. Primary rnmmoditie(sl to be mined: Sand Gravel Shale <br /> 5.1 Incidental commoditie(s) to be mined: 1. / Ibs/I'ons/vr 2. / Ibs/fons/vr 3. / lbs/1'ons/vr <br /> 4. 1 lbs/1'ons/yf 5. / Ibs/Tons/vr <br /> 5.2 Anticipated end tine of primary commoditie(s) to be mined: Construction Aggregates <br /> 5.3 AnticipetedendaseofincidepWcommaditie(s)tobemined: Construction <br />